[Prevention of HLA antibody formation in patients with hemato-oncologic diseases by using leukocyte depleted blood preparations]. / Vermeidung der HLA-Antikörperbildung bei Patienten mit hämatoonkologischen Erkrankungen durch Einsatz leukozytendepletierter Blutpräparate.

OBJECTIVE: To determine the effect of transfusion therapy with leukocyte-depleted platelet concentrates in comparison to transfusion support with standard platelet concentrates on the frequency of HLA alloimmunization in hematologic-oncologic patients. DESIGN: Prospective randomized study. SETTING: Institute for Transfusion Medicine and Immunohematology at a University Hospital. PATIENTS: 52 hematologic-oncologic patients randomized in 2 groups. INTERVENTIONS: Exclusive substitution with leukocyte-depleted blood components (platelet concentrates and packed red cells, filter group) or with standard platelet concentrates and leukocyte-depleted packed red cells (control group). Determination of the development of HLA antibodies. RESULTS: 27% of the patients in the control group (4 out of 15) developed HLA antibodies in contrast to zero patients (0 out of 22) in the filter group (p < 0.02). CONCLUSIONS: The results of this comparative clinical study show that the consequent and exclusive support with leukocyte-depleted blood components is an effective approach for prevention of HLA alloimmunization in long-term substituted patients.

[Investigational and methodological difficulties in the demonstration of cryoglobulins]. / Interpretations- und methodische Schwierigkeiten beim Nachweis von Kryoglobulinen.

Cryoglobulins and cryofibrinogens are special forms of cryopathies. With regard to the clinical findings, determination and analysis of cryoproteins can support the diagnostics. Because cryoproteins occur in patients and healthy persons, occasionally it may be difficult to estimate the clinical significance. We determined and analyzed cryproteins in 47 patients with the following diagnoses: urticaria (8), morbus Raynaud (10), acrocyanosis (7), vasculitis (3), collagenosis (6), lupus erythematosus (2), suspect of cryoproteinemia (9) and of cryofibrinogenemia (2). There were cryoproteins in 42 patients of the following characteristics: immunoglobulins A, G, M (14), fibrinogen (2), immunoglobulins A, G, M together with fibrinogen (26) with a considerable predominance of IgM. There was no correlation between the diagnoses and the cryoprotein types, and therefore it is reasonable to determine cryoproteins in close cooperation with the clinics. Contamination of the cryoprecipitates with hemoglobin from red blood cells can simulate alpha 2-macroglobulin and cause misinterpretations.

A comparative study on the solid phase capture--platelet test, platelet adhesion immunofluorescence test and lymphocytotoxic test.

The sensitivity, specificity and reproducibility of the solid phase capture-platelet test (CPT) were compared with those of the platelet adhesion immunofluorescence test (PAIFT) and the lymphocytotoxic test (LCT). This study shows that CPT has a higher sensitivity than PAIFT (P < 0.001) and LCT (P < 0.01). The specificity was 86% lower than LCT (100%) (P < 0.01). Both the CPT test and PAIFT were comparable with regard to reproducibility (100%, 92%). The solid phase assay is easier to handle than PAIFT and LCT, allowing identification of HLA as well as of platelet specific antibodies. It is an efficient antibody screening test.

[Preoperative autologous blood donation]. / Die präoperative Eigenblutspende.

There are three basic forms of the 170-year-old autologous blood transfusion. The intraoperative and perioperative autologous blood transfusion and the preoperative autologous blood donation and retransfusion. The latter is a preferred task of blood transfusion services. Indications and contraindications have to be carefully considered. Each step from the decision for autologous donation to the retransfusion has to be carried out with the same conscientiousness as any other preparation of blood units and performance of hemotherapy. Although the interest in autologous blood deposit has increased in the last 5 years the percentage of autologous blood donation is very small. In order to include all suitable patients in an autologous predeposit programme a close and understanding cooperation between hospitals and transfusion services is necessary. The frequency of autologous blood donations decreases if these requirements are not complied with.

[Blood-saving procedures--transfusion medicine aspects]. / Blutsparende Verfahren--transfusionsmedizinische Aspekte.

Homologous blood can be spared by the donation and retransfusion of autologues blood which has to be supervised preferably or--in component therapy and longtime conservation--exclusively by transfusion medicine. In spite of the recently increasing interest in this form of blood substitute, the sparing effect is poor and of little importance, because it can only be applied in case of especially suitable patients and operations and it is more time- and cost-consuming than the homologous transfusion. The sparing effect could be increased if the method would be applied in all suitable patients and interventions. This aim should be strived for in every way because the autologous donation and retransfusion is the most secure form of transfusion.

[Statistical analysis of parameters which determine yield in continuous centrifugal plateletpheresis]. / Die statistische Auswertung der Parameter, die bei der kontinuierlichen Zentrifugal-Thrombozytenapherese den Ertrag bestimmen (Kurze Mitteilung).

In order to ensure the economical handling of thrombocyte preparations which cannot be dispensed of and provided in unlimited quantities as well as in the interest of an indulgent behaviour towards donors it is desirable to adjust the platelet content of preparations in such a way that it corresponds to a therapeutically required, but also sufficient concentration. For this purpose, it must be possible to assess the yield of an apheresis in advance. This can be made without any difficulties by applying an equation developed according to a mathematical-statistical analysis by a multiple and partial correlation from 120 cases of apheresis, which shows, however, that the yield does not depend on machine data, but in a decisive manner on the donor's initial platelet number and the separated total blood volume.

[Washed erythrocyte concentrates. A contribution to the problem of the effect of wash procedures and storage time on erythrocytes in the preparation of blood]. / Gewaschene Erythrozytenkonzentrate. Ein Beitrag zur Frage des Einflusses der Waschprozeduren und des Konservenalters auf die Erythrozyten des Präparates.

The question of how often erythrocytes should be washed in order to obtain a protein-free and therapeutically efficient unit of washed red blood cells is still controversial. To obtain more information regarding this problem, 6 X 15 units of whole blood were washed 1-6 times with a saline solution immediately and after 7, 14, 21, 28 and 35 days of storage. After each washing procedure the content of total protein, of immunglobulins A, G, and M and of complement factor C3 was determined in the supernatants, as well as the osmotic fragility in the corresponding erythrocyte sediments. The statistically analyzed results enabled us to describe the average degree of influences as equations and to recommend a preparation prescription. The results show that the protein levels decrease precipitously after the first and second washing procedures. The following 4 procedures have no significant effect. On the other hand, with increasing time of storage more washing procedures are necessary to reach the same results than with younger units. That is also true for the concentrations of immunoglobulins and complement C3. The osmotic fragility of the erythrocytes increases with each washing procedure as well as each day of storage. According to these results, an optimal, protein-free and effective unit of washed red blood cells is obtained when a 1-2-week-old unit of whole blood is washed 2-3 times.

Lymphocyte surface marker studies in the diagnosis of unexplained lymphocytosis.

Fifty-six patients with unexplained lymphocytosis were investigated with a panel of antibodies to lymphocyte surface antigens. In 23 the distribution of cell surface markers suggested reactive lymphocytosis. The remaining 33 patients showed a distribution of cell surface markers that indicated or suggested a diagnosis of B-cell lymphoproliferative disease. Two illustrative case reports show how such studies performed early in the investigation of unexplained lymphocytosis may permit earlier diagnosis of the underlying mechanism.